Soft tissue diagnostic apparatus and method

ABSTRACT

A soft tissue diagnostic apparatus for diagnosis of stress and injury in anatomical soft tissue by detecting the response of the soft tissue to acoustic energy and a method of detecting soft tissue damage or stress and treating the tissue. An acoustic transmitter transmits excitation acoustic energy toward a target area of soft tissue of a subject. An acoustic receiver receives responsive acoustic energy generated by the soft tissue in response to the excitation acoustic energy transmitted by the acoustic transmitter and generates an output signal representative of the response of the soft tissue to the excitation acoustic energy. An analyzer receives the output signal of the acoustic receiver and provides an indication of at least one of stress and injury in the soft tissue based on the output signal. Areas of stress are inhibited to find the origin of soft tissue pain.

RELATED APPLICATION DATA

[0001] This application claims benefit of Provisional Application SerialNo. 60/274,614 filed on Mar. 12, 2001, the disclosure of which isincorporated herein by reference. This application is a continuation ofco-pending application Ser. No. 09/987,197 filed on Nov. 13, 2001, whichis a continuation-in-part of application Ser. No. 09/562,964 filed onMay 3, 2000, which claims benefit from provisional application Ser. No.60/132,169 filed on May 3, 1999.

BACKGROUND OF THE INVENTION

[0002] 1. Field of the Invention

[0003] The invention relates to diagnosis and treatment of soft tissuepain. More particularly, the invention is a method and apparatus formeasuring responses of soft tissue subject to acoustic stimulation,processing the response, and interpreting the response to indicate thelocation of stress and/or injury in soft tissue and for verifying theeffectiveness of treatment of soft tissue.

[0004] 2. Description of the Related Art

[0005] Existing techniques for diagnosis of the source of pain in softtissue are relatively subjective and inaccurate. Typically, cliniciansrely upon responses to patient questionnaires, medical histories, andsubjective observation to diagnose the source of pain in soft tissue.These tools are inherently imprecise even when used in a meticulousmanner. Several expensive technologies have been applied to diagnosis ofthe source of soft tissue pain. For example, magnetic resonance imaging(MRI), x-rays, and computerized tomography (CT) are known noninvasivetechnologies. Invasive technologies include nerve blocks, probes, andthe like. Even when utilizing these technologies, results are frequentlyinaccurate or inconclusive. Multiple studies have shown that x-rays havelittle value in routine examination of the source of soft tissue pain.Even MRI is now only rarely recommended in back pain, since surgerybased on such imaging has had a high failure rate. Moreover, thedemonstration of abnormal scans and x-rays in people who lack back painsymptoms casts serious doubt upon the value of these technologies insoft tissue diagnosis.

[0006] Other diagnostics have little value in diagnosing the source ofsoft tissue pain. Nerve conduction studies and electromyography areindicated for detection of nerve damage only at advanced stages.Measurement devices for indicators of tissue mobility or tension arelimited in scope and applicability. Ultrasound may image large muscletears and can depict certain tissue, but not specifically pain or stressin tissue. Nerve blocks may identify an area of pain but are not suitedfor routine evaluation because skilled administration of injectedanesthetic agents are required and risk factors are elevated. Blood flowanalyses also have limited relevance to soft tissue pain.

[0007] Serum and saliva analyses for substances associated with painhave been used to diagnose the source of pain. However, protocols,norms, and standardization of sampling and processing techniques haveyet to be established for such analyses. One theory is thatvisualization of chronic neck-shoulder pain can be achieved through thequantification of lowered microcirculation. However, this quantificationrequires the insertion of optical laser-Doppler single-fibers into twomuscle sites concurrently with increased static contraction usingelectromyography. Of course, this method, even If proven to be accurate,is painful and has a high risk factor.

[0008] It is known to use acoustic energy to determine physicalproperties of various nonliving materials. Also, acoustic energy hasbeen used In various medical applications. For example, U.S. Pat. No.5,795,311 discloses an apparatus for treating tissue by impartingacoustic energy thereto. U.S. Pat. No. 5,458,130 discloses an apparatuswhich applies ultrasonic energy for measuring bone density, andstrength, and for treating musculoskeletal tissue using a complex signalgenerator and processing system. U.S. Pat. No. 4,509,524 discloses adevice for characterizing tissue based on reflected ultrasonic waves.U.S. Pat. No. 4,819,621 discloses an apparatus for detecting cavitationin tissue injuries by detection of a reflected acoustic signal. U.S.Pat. No. 4,216,766 discloses an apparatus for treating tissue byapplying acoustic energy at the resonant frequency of a gas filledcavity surrounding the tissue to be treated. U.S. Pat. No. 5,115,808discloses an apparatus for measuring the velocity of acoustic signals intissue for determining the shear elastic properties of the tissue. U.S.Pat. No. 5,545,124 discloses a method for alleviating pain by chargingtissue with acoustic shockwaves. However, the prior art does not permitreliable detection of stress in soft tissue through noninvasivemeasures. Accordingly, the prior art fails to provide a method orapparatus for diagnosing the source of pain due to soft tissue damage orstress.

[0009] Therefore, a vast area of difficult and often intractablesyndromes of pain defy quantification and thus are difficult to treat ina reliable manner. Conventional diagnostic investigation often yieldslimited or equivocal findings, and involves expensive, painful andindirect methods. It follows that, therapeutic measures are compromisedby this lack of resources.

[0010] The phrase “soft tissue” as used herein includes muscles,ligaments, connective tissue and fascia, nerve and blood vessel walls,and other essential structures of the body. Diagnostic designationsrelating to these tissues include chronic pain, strain, musculoskeletalpain and injury, myofascial pain and injury, benign, non-malignant, oridiopathic pain; myalgia, fibrositis, or fibromylalgia; repetitivestrain injury (RSI) or overuse injury, including carpal tunnel syndrome(CTS), epicondylitis, tennis elbow, bursitis and tendinitis,temporomandibular joint disorder (TMD or TMJ), orofacial and neck pain,several types of headache, pelvic pain of unknown etiology, and backpain (all of which are included in the classification of “soft tissuepain” as used herein). The onset of soft tissue pain may have had anidentifiable traumatic component but the duration of the pain often farexceeds the expected physiological process of recovery. Gross damage anddisease processes are often absent with soft tissue pain.

[0011] The economic impact of soft tissue pain is reported by suchstudies as those of the annual combined cost of back pain-relatedmedical care and disability compensation, which alone may reach $50billion annually in the U.S. Back pain affects about 31 millionAmericans, is the leading cause of activity limitation in young adults,and generates annual U.S. productivity losses in the range of $28billion. Incidence of tension-type headaches has been reported as highas 48.9%, with numerous annual lost workdays and days of decreasedeffectiveness at work, home, or school. Neck pain occurred at a 34% ratein one study. These statistics are representative of the magnitude ofthe of soft tissue pain which is severely hampered by lack of efficientdiagnosis. It is frequently difficult to differentiate between specificconditions which benefit from surgery and those which do not. Despitedue care in evaluation, surgery fails a significant percentage ofpatients who do not obtain relief and whose condition may even worsen.Conversely, surgical interventions performed for non-pain reasons arethemselves a recognized cause of chronic soft tissue pain which isdifficult to identify.

SUMMARY OF THE INVENTION

[0012] It is an object of the invention to facilitate detection ofabnormalities, such as stress and damage of soft tissue in anon-invasive manner.

[0013] To achieve these objects, a first aspect of the invention is asoft tissue diagnostic apparatus for detecting abnormalities inanatomical soft tissue by detecting the response of the soft tissue toacoustic energy. Said apparatus is comprised of comprising an acoustictransmitter configured to transmit excitation acoustic energy toward atarget area of soft tissue of a subject, an acoustic receiver configuredto receive responsive acoustic energy generated by the soft tissue inresponse to the excitation acoustic energy transmitted by said acoustictransmitter, said acoustic receiver generating an output signalrepresentative of the response of the soft tissue to the excitationacoustic energy transmitted by said acoustic transmitter. Said apparatusalso contains an analyzer coupled to said acoustic receiver to receivethe output signal of said acoustic receiver and to provide an indicationsignal of at least one of stress and injury in said soft tissue based onsaid output signal of said acoustic receiver, and a pressure deviceconfigured to apply pressure to areas of the soft tissue having amaximum response of the soft tissue to the excitation acoustic energy oftransmitted by said acoustic transmitter.

[0014] A second aspect of the invention is a method of detectingabnormalities in anatomical soft tissue by detecting the response of thesoft tissue to acoustic energy. The method comprises: (a) determining anarea of soft tissue having a localized characterized acoustic response;(b) applying pressure to the area of maximum responsive acoustic energyto inhibit acoustic response of the area while simultaneouslytransmitting excitation acoustic energy toward the area and receivingresponsive acoustic energy generated by the area; (c) repeating saidsteps (a) and (b) for each of the plural target areas while applyingpressure to all previously detected target areas; (d) when all responseshave been inhibited by application of pressure, a location ofcharacteristic acoustic response will be identified that is notresponsive to efforts to inhibit it, i.e., the inhibitory effort willnot exceed the maximum previously applied pressure. This determines thetarget area as a treatment location.

[0015] A third aspect of the invention is a device for detectingabnormalities in soft tissue comprising, a housing, an acoustictransmitter disposed in said housing and configured to transmitexcitation acoustic energy toward a target area of soft tissue of asubject, an acoustic receiver disposed in said housing and configured toreceive responsive acoustic energy generated by the soft tissue inresponse to the excitation acoustic energy transmitted by said acoustictransmitter, said acoustic receiver generating an output signalrepresentative of the response of the soft tissue to the excitationacoustic energy transmitted by said acoustic transmitter, and a pressuredevice operatively coupled to said housing and configured to applypressure to the target area of the soft tissue.

BRIEF DESCRIPTION OF THE DRAWING

[0016] The invention will be described through a preferred embodimentand the attached drawing in which:

[0017]FIG. 1 is a block diagram of a diagnostic apparatus of thepreferred embodiment;

[0018]FIG. 2 is a sectional view of a stabilizer of the preferredembodiment;

[0019]FIG. 3-8 are graphs of the response of soft tissue under variousconditions when tested with the preferred embodiments; and

[0020]FIG. 9 is a sectional view of an alternative stabilizer of thepreferred embodiment.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT

[0021] Scientific research has identified a model called “tensegritywhich provides form, flexibility, communication, response, strength andresilience throughout the body's structure. The tensegrity structuralcomponents of the body, from DNA and cytoskeleton to entire cells andtissues, exhibit characteristic resonant frequencies of vibration.Studies have shown that the matrix of tensegrity maintains a forcebalance which provides a means to integrate mechanics and biochemistryat the molecular level. Physical forces are converted into biologicalresponses when mechanically induced information is transmitted throughthe molecular and cellular complexes. The tensegrity networks of thebody mediate this mechanotransduction; their organizations have beenfound to function as coupled harmonic oscillators. Suchmechanotransduction significantly influences cell function, tissuegrowth and remodeling, gene expression, and participates with ionchannels, signaling molecules, proteins, lipids, chemical transmittersand more.

[0022] At the tissue level, ligaments, fascia, muscles, bones, and bloodvessels demonstrate tensegrity structure and properties in theirindividual and intertwined organizations. These components constantlyreceive input and perform or adapt in response, demonstrating mechanicalcommunication and information processing. The nervous system is anothertype of communication network involved with responses to internal orexternal stresses. In located areas or centrally in the brain, neuraltissue plays a large role in processing information, directing actionand maintaining homeostasis. Neurally mediated responses such asvoluntary movement, involuntary functions, and self protective reactionsinvolve signal transfer processes. This communication is facilitated bythe tensegrity structure on the cellular level and through nervepathways as well as through tensegrity relationships between themusculoskeletal and other tissue participants.

[0023] The body's interactions with its internal and externalenvironment involve a high level of complexity and coordination, yet theintegrated network responds instantly. This is possible because the bodyis always in readiness at a level of internal tone called pre-stress, anisometric/elastic state which supports immediate mechanicalresponsiveness, in addition to essential balance, decompression, formand stability. Elevation of the normal pre-stress threshold interfereswith the resiliency of the network. Translated to the soft tissues,excessive pre-stress causes restriction, stiffness, compression, andasymmetrical organization. Many cellular processes are altered oraffected, including transmembrane receptors which participate in paingeneration.

[0024] Perpetuation and proliferation of these stresses result in tissuerestriction and pathological adhesions, causing immobility and pain.Inflammatory responses may also be stimulated, producing pain signalingsubstances. Nerves may be irritated through traction or compression aswell as biochemical transmission, providing yet another link betweenmechanical tensional dysfunctions and pain generation. Conduction offorces can lead to elevated stresses that are isolated or, more likely,networked into a domino effect, being recruited into patterns ofreaction, reinforcement and compensation. Dysfunction can proliferatethroughout the tensegrity system. Therefore, diagnosis needs to besite-specific to the latent reaction that is perpetuating the strain andelevated pre-stress and it needs to be sensitive to the hierarchicalcompensatory and stabilizing strain relationships.

[0025] The parent application, the disclosure of which is incorporatedherein by reference, discloses the detection of “barriers” and“anchors”. Barriers are areas of soft tissue stress reaction thatexhibit tensional restriction of mobility when assessed throughpalpation and other techniques. Barriers are the result of irritationand strain patterns originating from stress reactions of the tissue atthe anchor location. Anchors, sometimes referred to as “interfaces”herein, are the ultimate origin of the soft tissue injury and as suchneed to be precisely identified for accurate diagnosis of the injuryetiology and effective treatment results.

[0026] As disclosed in the parent application, the alteration of densityand tensile qualities of soft tissue due to stress changes the impedanceand/or dispersion thereof, thus affecting acoustic properties thereof.The persistent state of elevated pre-stress that remains followingexcessive demand may significantly participate in the condition commonlyidentified as soft tissue injury. Thus, altered tensional dynamics ofthe soft tissue produce idiosyncratic acoustical responses which can beutilized as diagnostic indicators.

[0027] The preferred embodiment quantifies acoustical responses of softtissue to locate specific sites of tensional involvement and thusdiagnose soft tissue stress or injury and to confirm the effectivenessof treatment thereof. Accordingly, the preferred embodiment drasticallyreduces the level of skill required to locate and treat soft tissueinjuries.

[0028]FIG. 1 is a block diagram of a diagnostic apparatus according to apreferred embodiment of the invention. Apparatus 10 includes processor12 as an analyzer. In the preferred embodiment processor 12 is amicroprocessor based digital device, such as a personal computer.However, any type of analyzer can be used, such as an analog signalprocessor, or the like. Processor 12 includes multichannel analog todigital converter A/D 16. Of course, if processor 12 is analog, A/D 16can be omitted and replaced by appropriate analog signal interfaces.Processor 12 of the preferred embodiment also has memory device 18,which can include one or more of a random access memory (RAM), amagnetic disk memory device, an optical memory device, or the like, forstoring instructions of a control program. Processor 12 also has centralprocessing unit (CPU) 20 for executing the instructions of the controlprogram. Display 30 is coupled to processor 12 to display test results,variables, and the like.

[0029] Signal generator 22 is configured to generate an electricalsignal of predetermined frequency as described below. The operator canadjust the frequency of the electrical signal or select a progression offrequencies to be generated by signal generator 22 in a known manner.Amplifier 24 receives the electrical signal from signal generator 22 todrive speaker 25 serving as an audio source. The audio source can be anytransducer capable of producing an acoustic vibrational signal inresponse to electrical impulses or other signals, such as a conespeaker, a planar driver speaker, or a piezoelectric device. Also, thesignal provided to the audio source can be of any appropriate type.Signal generator 22, amplifier 24, and speaker 25 constitute an acoustictransmitter in the preferred embodiment. However, the acoustictransmitter can be any device for transmitting acoustic energy, such asa tuning fork, a tone generator, or the like. Preferably, the audiosource is highly directional to be capable of isolating particular softtissue areas.

[0030] Audio sensor 26 and audio sensor 27 are coupled to A/D 16 ofprocessor 12 through multi channel amplifier 28. Audio sensors 26 and 27and amplifier 28 constitute an acoustic receiver of the preferredembodiment. However, the acoustic receiver can be any device forreceiving acoustic energy and distinguishing characteristics thereof,such as a selective resonator, the operators ear, or the like. Sensors26 and 27 can be microphones, styli, piezoelectric vibration sensors,optical motion sensors, accelerometers, or any other transducer capableof directly or indirectly sensing acoustic energy or motion andoutputting a signal related thereto. Sensors 26 and 27 can be contactsensors or non-contact sensors. As will be seen below, sensor 26 servesto detect soft tissue response to acoustic energy and sensor 27 servesto detect background acoustic energy. Processor 12 can include thenecessary processing circuitry or software to eliminate backgroundnoise, such as 60 Hz hum and noise detection by sensor 27, to eliminateany undesired phase or amplitude of the received signal, or tootherwise, linearize, manipulate, transition or enhance the signalsreceived from multi-channel amplifier 28. For example, if microphones orany other non contact sensor are used as audio sensors 26 and 27, it maybe necessary to correct for the phase delay of the audio signal due tothe finite velocity if sound to avoid errors due to direct couplingbetween speaker 25 and audio sensor 26. Preferably, audio sensor 26 isdirectional to a high degree to minimize noise and environmentaleffects. Signal generator 22, amplifier 24 and amplifier 28 can beincorporated in processor 12. For example, a conventional sound card orinterface can be used if processor 12 is a personal computer.

[0031] In the preferred embodiment, sensor 26, sensor 27 and speaker 25are integrated into stabilizer 50 as illustrated in FIGS. 1 and 2.Stabilizer 50 includes housing 52 of a substantially spherical shape inthe preferred embodiment. Preferably housing 52 is somewhat flexible topermit the surface thereof to conform to various anatomical surfaces.Sensor 26, sensor 27, and speaker 25 are electrically connected to othercomponents, as disclosed above, through wiring harness 54 and connector56. Note that sensor 27 is remote from a portion of stabilizer 50, thebottom portion in FIG. 1, that will be placed in contact with tissue.Insulating material 58 is disposed in housing 52 to isolate thecomponents in housing 52. As will become apparent below, it is necessarythat stabilizer 50 be sufficient mass to inhibit the characteristicacoustic response. For example. Insulating material 58 can be of amaterial that imparts such mass to stabilizer 50. Stabilizer 50 can alsoinclude a separate pressure member, such as a weight, a pressure strapor the like, to exert the requisite pressure on tissue as discussedbelow.

[0032] To use diagnostic apparatus 10 for diagnosis of soft tissuedamage or stress, soft tissue S of a patient is placed proximate speaker25 to be in the path of acoustic energy generated by speaker 25, asillustrated in FIG. 1. In the preferred embodiment stabilizer 50 can beplaced directly on tissue. Soft tissue S is then stimulated with variousfrequencies of acoustic energy from speaker 25 to determine a frequencyof maximum response amplitude as detected by sensors 26. The frequencyof maximum response can be used for further testing. For example,frequencies between 100 and 1000 Hz can be used at 70-90 db.

[0033] A barrier is then located using known techniques, such as thepalpation technique disclosed in the parent application. Stabilizer 50is placed on the barrier site so that sensor 26 is opposite the tissuethereof. Sensors 26 and 27 are monitored while the tone is generated andthe output signal thereof is recorded in memory 18 and processed asdescribed below.

[0034] Applicant conducted tests using diagnostic apparatus 10 of thepreferred embodiment to confirm the effectiveness thereof and therepeatability of data acquired thereby. In the tests, sites ofcharacteristic acoustic response indicating tension were located by atrained therapist using conventional techniques. However, these sitescan be located using the apparatus of the preferred embodiment.Applicant has found that there can be plural areas of soft tissuetension, i.e. multiple sites of characteristic acoustic responsesidentifiable in the body of one patient who presents for diagnosisand/or treatment. Application of sufficient pressure to the location oftension will reduce the tension and characteristic tension acousticresponse at that area. This is referred to as “inhibition” or“inhibiting” herein. Inhibition also enhances the elucidation ofacoustic detection of other areas which relate to the soft tissuedysfunction and the location of the interface which is the site ofneural responses that are the origin of pain as described below.

[0035] Applicant postulates that there are locations in the soft tissuethat contain the neural and other activities that produce soft tissuedysfunction (the “interface”). The interface creates compensatory andreactive tensions in other locations and structures that are affected tocope with the dysfunction. These compensatory tensions have acharacteristic acoustic response. The response and tension of each canbe reduced and minimized by light to moderate pressure applied by aweighted object, such as stabilizer 50, placed on top of the body partor an object (collectively referred to as the “pressure device”) placedon or underneath the body part and pushing on the body part. When theacoustic responses and tensions are sufficiently inhibited by pressureat the appropriate locations, the generalized acoustic responses areminimized to the point of near total disappearance. When this has beenachieved, a site of unique acoustic response, the interface, will bedetectable at the location of the origin of pain, making it apparent andamenable for treatment and alleviation.

[0036] The procedure for finding the interface can be carried out in thefollowing manner. First, an area of characteristic acoustic responseindicating tension is determined through frequency and location ofmaximum acoustic response using techniques disclosed above. The pressuredevice is then applied in the general area, stimulating the frequencyand adjusting position of the device until the acoustic response isminimized. This step is repeated until all acoustic responses at othersites are identified and blocked as described above. This may or may notbe accomplished by locating the sites in order of magnitude of response.At this point, a location of unique response can be determined using theacoustic response characteristics disclosed above. This location ofunique response, the interface, is the area to be treated using physicaltherapy. The following is a description of testing using stabilizer 30in connection with diagnostic apparatus 10.

[0037] A subject was laid on a bodywork table and locations of softtissue stress were identified using a therapist and a tuning fork in themanner described in provisional application Ser. No. 60/132,169, thedisclosure of which is incorporated herein by reference. A firstlocation of the greatest stress identified in this manner was theninhibited by placing stabilizer 50, having a weight of approx. 2-lb.(i.e., of sufficient mass to inhibit the characteristic acousticresponse), on the location of greatest stress, and acoustic response ofthe tissue was measured. The graph of this data is shown in FIG. 3. Itcan be seen that, at the fundamental stimulation frequency of 322.30 Hzthe resulting voltage of the response signal was 2.22 volts. The voltageof the response signal at the first harmonic, 961.03 Hz, was 1.27 volts.

[0038] Stabilizer 50 was removed from the first location and aninhibition weight of about 2 lbs. was placed on the first location toinhibit response of the first location. A therapist then identified asecond location of soft tissue stress. This site was also inhibited, andacoustic response was measured, using stabilizer 50. FIG. 4 is a graphof this response. It can be seen that, at the fundamental stimulationfrequency of 322.30 hz the resulting voltage of the response signal was3.52 volts. The voltage of the response signal at the first harmonic,961.03 hz, was 0.98 volts.

[0039] With the first and second locations inhibited, a third locationof stress was identified by a therapist. While inhibiting the first andsecond locations, measurements were taken at the third location usingstabilizer 50. FIG. 5 is a graph of the uninhibited response at thethird location with the other locations being uninhibited. It can beseen that, at the fundamental stimulation frequency of 322.30 Hz, theresulting voltage of the response signal was 2.91 volts. The voltage ofthe response signal at the second harmonic, 961.03 Hz, was 0.65 volts.FIG. 6 is a graph of the inhibited response at the third location withthe other locations being inhibited. It can be seen that, at thefundamental stimulation frequency of 322.30 Hz, the resulting voltage ofthe response signal was 2.17 volts. The voltage of the response signalat the first harmonic, 961.03 hz, was 1.06 volts.

[0040] The first, second and third locations were inhibited and thetherapist could identify only one other location, the fourth location inthis case, of high soft tissue stress. This final location of stress isthe interface discussed above. Uninhibited acoustic response wasmeasured at the fourth location using stabilizer 50 with all otherlocations inhibited. FIG. 7 is a graph of the response at the fourthlocation with other locations inhibited. It can be seen that, at thefundamental stimulation frequency, the resulting voltage of the responsesignal was 3.35 volts. The voltage of the response signal at the secondharmonic was 0.52 volts. All the inhibition weights were then removedfrom the subject and the measurement at the fourth site was repeatedwith stabilizer 50. FIG. 8 is a graph of the response at the fourthlocation with other locations not inhibited. It can be seen that, at thefundamental stimulation frequency, the resulting voltage of the responsesignal was 2.63 volts. The voltage of the response signal at the firstharmonic was 0.33 volts.

[0041] As shown in the graphs of FIGS. 4-8, the voltage measured at thenon-interface locations decreased when inhibition pressure was appliedto other locations. However, the interface site voltage was larger whenall other locations were inhibited, and decreased when the inhibitionpressure at other locations was removed. It can be seen that theinterface, while being the origin of pain and the best location fortreatment is only ascertainable after location and inhibition of otherstress locations.

[0042]FIG. 9 illustrates and alternative stabilizer 150 in which housing152 is in the shape of an inverted pyramid. This shape presents a flatsurface to opposes soft tissue and may be better suited to largesomewhat planar anatomical surfaces. All other aspect of stabilizer 150are similar to stabilizer 50 and like elements are labeled with similarreference numerals have the prefix of “1.” The stabilizer can be used togather information regarding each location of soft tissue stressidentified by a therapist or the sensor instrument disclosed in theparent application. The data could be used to monitor the continuedinhibition of each stabilized location, and can be used to characterizelocations of soft tissue stress and their interrelation with each other.

[0043] As noted above, the acoustic transmitter and/or receiver can beintegrated into the pressure device. In such a case, the source andsensors can contact the tissue. Alternatively, separate contact ornon-contact transmitters and/or receivers can be used. The electricalsignal generated by the signal generator can be of a constant frequencyor of a variable frequency over time to find the frequency of maximumresponse. The frequency can be varied manually in response to operatorinput or through the control program in a predetermined manner. Forexample, the frequency can initially be 100 Hz and can be varied inincrements of 50 Hz up to 1 kHZ. Applicant has found that most stressedor damaged soft tissue will respond to a frequency within this range. Ofcourse, the range of frequencies, the incremental change, and the rateof change can be varied based on various practical considerations. Also,the amplitude of the acoustic energy signal can be varied as needed.

[0044] The audio sensor can be positioned to detect vibration (i.e.,responsive acoustic energy) of particular portions of the soft tissue,in response to the acoustic energy generated by the speaker. Forexample, particular nerves, muscles, ligaments, or the like can beinvestigated. The audio sensors can be placed over the soft tissuepercutaneously or can be directed toward the soft tissue depending onwhether the audio sensor is of a type that senses in a contact ornon-contact state. Audio sensors employing ultrasound techniques can beused to detect Doppler effects due to resonance of interior organs,blood vessels, or other tissue to permit diagnosis of internal tissuedamage or stress. Additional sensors can be used depending on theapplication and desired resolution of results. Any type of processingcan be used to distinguish the response signal of abnormal tissue fromthat of normal tissue.

[0045] As noted above, applicant has found that stressed or damaged softtissue will respond to a frequency of excitation acoustic energy in amanner that is distinguishable from the response of normalized tissue.Accordingly, stressed and damaged tissue can be distinguished fromnormalized tissue and accurately located and treated. Also, theeffectiveness of treatment can be verified by measuring acousticresponse after treatment. These capabilities are especially desirablebecause often the stressed or damaged tissue is remote from the apparentlocation of pain indicated by the patient. Testing can provide baselinesof normalized tissue to be compared with results of tissue being tested.For example, testing may indicate that a particular area of a patient'shand, in a normalized state, has a particular acoustic profile, transferfunction or power spectrum. This can be compared with test results todetermine if tissue is stressed or damaged. The control program of theprocessor can correct any non linearities based on calibration with aknown element used in place of the soft tissue.

[0046] Living tissue has a complex structure, and not surprisingly, ishighly dispersive at acoustic frequencies. To elucidate the differencein acoustic response of stressed and nonstressed sites, the controlprogram of the processor should include instructions for performingprocessing of data, i.e., response signals, collected by the sensor. Anyappropriate processing can be accomplished on the response signals.

[0047] Any type of acoustic transmitter and receiver can be used. Theanalyzer can be configured to accomplish various processing of thesensor signals, such as filtering, transforming, shifting, amplifying,and attenuating. Any type of acoustic sensor can be used. The sensorscan be disposed to sense acoustic response of various locations. Theinvention can be used on any type of soft tissue.

[0048] While the invention has been described through a preferredembodiment, various modifications can be made without departing from thescope of the invention as defined by the appended claims.

What is claimed is:
 1. A soft tissue diagnostic apparatus for detectingabnormalities in anatomical soft tissue by detecting the response of thesoft tissue to acoustic energy comprising: an acoustic transmitterconfigured to transmit excitation acoustic energy toward a target areaof soft tissue of a subject; an acoustic receiver configured to receiveresponsive acoustic energy generated by the soft tissue in response tothe excitation acoustic energy transmitted by said acoustic transmitter,said acoustic receiver generating an output signal representative of theresponse of the soft tissue to the excitation acoustic energytransmitted by said acoustic transmitter; an analyzer coupled to saidacoustic receiver to receive the output signal of said acoustic receiverand to provide an indication signal of at least one of stress and injuryin said soft tissue based on said output signal of said acousticreceiver; and a pressure device configured to apply pressure to areas ofthe soft tissue having a maximum response of the soft tissue to theexcitation acoustic energy of transmitted by said acoustic transmitter.2. An apparatus as recited in claim 1, wherein said transmittercomprises a first transducer said receiver comprises a second transducerand wherein said first transducer and said second transducer areintegrated with said pressure device.
 3. An apparatus as recited inclaim 1, wherein said pressure device is a weight that is separate fromsaid transmitter and said receiver.
 4. An apparatus as recited in claim2, wherein said receiver further comprises a third transducer integratedwith said pressure and operative to receive background acoustic energy,and wherein said analyzer is operative to subtract a signal from saidthird transducer from a signal from said second transducer to correct atleast one of background noise and minimize other instrumental artifacts.5. A method of detecting abnormalities in anatomical soft tissue bydetecting the response of the soft tissue to acoustic energy, saidmethod comprising: (a) determining an area of soft tissue having alocalized characteristic acoustic response; (b) applying pressure to thearea of localized characteristic acoustic response to inhibit acousticresponse of the area while simultaneously transmitting excitationacoustic energy toward the area and receiving responsive acoustic energygenerated by the area; (c) repeating said steps (a) and (b) for each ofthe plural areas while applying pressure to all previously detectedareas; (d) when all responses have been inhibited by application ofpressure, identifying a treatment location of characteristic acousticresponse that is not responsive to efforts to inhibit it.
 6. A method asrecited in claim 5, wherein said step (a) comprises transmittingexcitation acoustic energy toward an area of soft tissue of a subject,receiving responsive acoustic energy generated by the soft tissue inresponse to the acoustic excitation energy, and determining an area ofsoft tissue having a localized maximum responsive acoustic energy.
 7. Adevice for detecting abnormalities in soft tissue comprising: a housing;an acoustic transmitter disposed in said housing and configured totransmit excitation acoustic energy toward a target area of soft tissueof a subject; an acoustic receiver disposed in said housing andconfigured to receive responsive acoustic energy generated by the softtissue in response to the excitation acoustic energy transmitted by saidacoustic transmitter, said acoustic receiver generating an output signalrepresentative of the response of the soft tissue to the excitationacoustic energy transmitted by said acoustic transmitter; and a pressuredevice operatively coupled to said housing and configured to applypressure to areas of the soft tissue having a maximum response of thesoft tissue to the excitation acoustic energy of transmitted by saidacoustic transmitter.
 8. A device as recited in claim 7, wherein saidpressure device is a mass disposed in said housing to impart substantialweight to the device.
 9. A device as recited in claim 7, wherein saidreceiver further comprising a background acoustic receiver disposed insaid housing and operative to receive at least one of backgroundacoustic energy and instrumental artifacts.